Reversible Pituitary Dysfunction in a Patient with Cushing's Syndrome Discovered as Adrenal Incidentaloma

Endocrine Journal

Tomoko MIYOSHI¹  Toshio OGURA¹  Naomi WATANABE¹  Hirofumi MAKINO¹  Kenichi INAGAKI¹  Fumio OTSUKA¹  Jiro SUZUKI¹ 

[1] Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine and Dentistry

关键词: Cushing's syndrome;    Prolactin (PRL);    Gonadotropin;    Adrenocorticotropin (ACTH);    Hypercortisolemia;    Incidentaloma;   

DOI  :  10.1507/endocrj.51.201

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(22)Cited-By(3)We report a 45-year-old woman with Cushing's syndrome showing reversible pituitary dysfunction. Left adrenal tumor was incidentally discovered by a screening examination of abdominal computed tomography. Although this patient lacked typical Cushingoid features except hypertension and leg edema, endocrine examinations revealed moderate suppression of plasma ACTH (~6.3 pg/ml) with relatively high levels of serum cortisol (~22.9 μg/dl) without normal circadian rhythm. Plasma ACTH failed to respond to either CRH or metyrapone, and dexamethasone failed to suppress her daily steroid production. Surgical removal of left adrenocortical adenoma and 6-month replacement of hydrocortisone have ameliorated both ACTH and cortisol responses to CRH loading test. Postoperative responses of TSH and GH to TRH and GRH, respectively, were two fold higher than the preoperative levels. In contrast, basal and TRH-induced levels of serum PRL were decreased after surgery although both the basal and stimulated PRL levels were markedly high before surgery. In addition, gonadotropin response to GnRH examined in the same ovarian cycle was decreased in accordance with an increase in serum estradiol and progesterone levels after surgery. Improvement of hypercortisolemia even in a moderate case of Cushing's syndrome not only ameliorates hypertension, obesity and glucose intolerance, but also restores the accompanying dysfunctions of anterior pituitary, suggesting the clinical importance of early discovery and treatment of functioning adrenocortical incidentalomas.

【 授权许可】

Unknown